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Annals of Plastic Surgery Apr 2023Given that the use of breast implants for both cosmetic and reconstructive purposes is growing in the United States, an evaluation of factors that may affect the outcome...
Given that the use of breast implants for both cosmetic and reconstructive purposes is growing in the United States, an evaluation of factors that may affect the outcome of breast implant surgery is needed. A systematic review was conducted to evaluate the question: Does a personal or family history of autoimmune disease affect outcomes in breast implant surgery? The literature search yielded 2425 records, but after removal of duplicates, abstract screening, and full-text assessment, only 2 studies met the inclusion criteria for the final review. Both studies provided level III evidence and the average Methodological Index for Non-Randomized Studies score was 16.5 (range, 15-18 of 24), indicating a fair level of evidence overall. This systematic review found no evidence to support that a diagnosis of an autoimmune disease and/or a family history of autoimmune diseases will lead to poor surgical outcomes in breast implant surgery. Further study is warranted.
Topics: Humans; Breast Implants; Breast Implantation; Autoimmune Diseases; Plastic Surgery Procedures; Mastectomy
PubMed: 34117137
DOI: 10.1097/SAP.0000000000002930 -
The Turkish Journal of Pediatrics 2022Phthalates are ubiquitous in the environment and they can penetrate the human body via multiple routes. However, the impact of phthalates on human male reproductive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Phthalates are ubiquitous in the environment and they can penetrate the human body via multiple routes. However, the impact of phthalates on human male reproductive disorders remains unclear.
METHODS
A critical review of published studies was conducted to clarify the association of phthalates and male reproductive disorders and to highlight future research needs. PubMed, Cochrane Library, and Web of Science Database were systematically searched for relevant articles written in English, independent of region and time period. If more than one paper overlapped in study design or participants included, the most recent manuscript was included in our review. Due to limited homogeneous statistical data, observed trends were summarized to draw approximate conclusions.
RESULTS
Nineteen manuscripts were included in our final analysis. Exposure to di-(2-ethylhexyl) phthalate (DEHP), di-n-butyl phthalate (DBP), diethyl phthalate (DEP), and/or benzyl butyl phthalate (BBP) is associated with a shorter anogenital distance (AGD). Meanwhile, exposure to DEHP and/or di-isodecyl phthalate (DIDP) is associated with higher risks for cryptorchidism and hypospadias.
CONCLUSIONS
Generic exposure to phthalates has an adverse effect on human reproductive development, especially exposure to DEHP, DBP, DEP, BBP, and DIDP. A critical time for exposure sensitivity is during early pregnancy. Due to the lack of significant statistical power in this study, the conclusions drawn should be cautiously interpreted and they remain to be validated. Thus, additional well-designed studies, as well as propaganda and education regarding phthalate exposure and safer substitutes for these compounds, are greatly needed.
Topics: Diethylhexyl Phthalate; Female; Humans; Male; Maternal Exposure; Phthalic Acids; Pregnancy
PubMed: 35611408
DOI: 10.24953/turkjped.2020.2060 -
Annals of Translational Medicine Apr 2021Transgender patients often desire to have biological children. However, their reproductive potential is often negatively impacted by gender affirming surgery (GAS) such... (Review)
Review
Transgender patients often desire to have biological children. However, their reproductive potential is often negatively impacted by gender affirming surgery (GAS) such as gender confirmation surgery (bottom surgery) and medical hormone therapy. Therefore, counselling patients on fertility preservation options before initiating gender-affirming treatments is prudent to avoid reducing their reproductive potential. A systematic review of English, Spanish, Chinese, French and Turkish languages from 2000 to December 23rd, 2019, using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines, was conducted. The search strategy was designed and conducted by an experienced librarian with input from the study's principle investigator. Fifteen articles that report outcomes of fertility preservation options in transgenders were included. Eight articles described options for transgender women, six reported options for transgender men and one included both transgender women and transgender men. Semen cryopreservation and oocyte cryopreservation are the most common and available methods for fertility preservation in transgenders. Physician awareness of fertility preservation options in transgender patients is crucial to ensure informed discussions regarding reproductive options in the early phase of transition.
PubMed: 33987311
DOI: 10.21037/atm-20-4523 -
The Lancet. Infectious Diseases Aug 2022WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical... (Meta-Analysis)
Meta-Analysis
Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials.
BACKGROUND
WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical site infections (SSIs). Existing meta-analyses that include studies at high risk of bias, combined with the recent publication of large, randomised trials, justify an updated meta-analysis of high-quality randomised controlled trials (RCTs). We aimed to test the rates of SSI according to skin preparation solutions (ie, alcoholic chlorhexidine vs aqueous povidone-iodine) and types of sutures (ie, coated vs uncoated).
METHODS
In this systematic review and meta-analysis, we searched MEDLINE, Embase, Pubmed, and Cochrane Library databases, with no language restrictions, to identify high-quality RCTs testing either alcoholic chlorhexidine skin preparation (vs aqueous povidone-iodine) or triclosan-coated sutures (vs uncoated sutures), or both, published from database inception to Sept 1, 2021. Patients who received clean-contaminated, contaminated, or dirty surgery were included. We predefined the characteristics of a high-quality trial through an expert consensus process to develop an enhanced Cochrane risk of bias-2 tool specifically for RCTs with a primary outcome of SSI. Data were extracted from published reports. Meta-analysis was performed using a random-effects model and heterogeneity was assessed using the I statistic. This systematic review and meta-analysis was prospectively registered in PROSPERO, CRD42021267220.
FINDINGS
Of 942 studies identified, 933 were excluded. Four high-quality RCTs (n=7467 patients) were included that tested alcoholic chlorhexidine. No significant difference in SSI rates was noted between alcoholic chlorhexidine and aqueous povidone-iodine (17·9% [667 of 3723 patients] vs 19·8% [740 of 3744 patients]; odds ratio 0·84 [95% CI 0·65-1·06]; p=0·21, I=53·1%). Five high-quality RCTs were included that tested triclosan-coated sutures (n=8619 patients), with no significant difference noted between triclosan-coated and uncoated sutures (16·8% [733 of 4360 patients] vs 18·4% [784 of 4259 patients]; OR 0·90 [95% CI 0·74-1·09]; p=0·29, I=36·4%).
INTERPRETATION
Contrary to previous meta-analyses, this study did not show a benefit from either alcoholic chlorhexidine skin preparation or triclosan-coated sutures, both of which are more expensive than other readily available alternatives. Global and national guidance should be reconsidered to remove recommendations for their routine use.
FUNDING
National Institute for Health Research (NIHR) Global Health Research Unit.
Topics: Anti-Infective Agents, Local; Chlorhexidine; Humans; Povidone-Iodine; Randomized Controlled Trials as Topic; Surgical Wound Infection; Sutures; Triclosan
PubMed: 35644158
DOI: 10.1016/S1473-3099(22)00133-5 -
The Science of the Total Environment May 2022A systematic review of research on marine macrolitter densities in the past five years (2015-2020) revealed considerable knowledge gaps in the field. Nearly half he... (Review)
Review
A systematic review of research on marine macrolitter densities in the past five years (2015-2020) revealed considerable knowledge gaps in the field. Nearly half he reviewed studies were on stranded litter. Data are scarce from many of the regions estimated to mismanage the largest amounts of plastic waste. In regions where data are available these are typically from coastal areas with few data from the high and deep seas; 57% and 87% of studies on pelagic and seafloor litter, respectively, took place within 100 km from shore. Data on pelagic litter are generally constrained to the sea surface and only two of 30 pelagic studies have measured macrolitter deeper in the water column. Reported litter densities are generally highest for stranded litter, although seafloor litter densities by weight are high in some areas. Reported densities of floating litter are several orders of magnitude lower. However, a lack of standardisation of methods makes it difficult both to assess and to compare litter densities within and across the different environmental compartments in time and space. The review illustrates a great need for survey design development within the field of macroplastics and point to some long-established considerations from ecological research pertaining to independence of data points, spatial autocorrelation, sampling scale, and plot size and shape which are highly relevant also for marine litter research. These considerations are relevant both for global standardisation efforts and for independent studies. Furthermore, the knowledge gaps created by geographic and compartment biases in research needs to be addressed to identify further research needs, validate models and inform policy.
Topics: Environmental Monitoring; Geography; Plastics; Time; Waste Products
PubMed: 35051476
DOI: 10.1016/j.scitotenv.2022.153162 -
Brazilian Oral Research Jun 2018Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for... (Meta-Analysis)
Meta-Analysis Review
Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54-1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57-4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37-2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.
Topics: Acrylic Resins; Biocompatible Materials; Bone Substitutes; Bone Transplantation; Humans; Polymethyl Methacrylate; Plastic Surgery Procedures; Risk Factors; Skull; Titanium; Transplantation, Autologous
PubMed: 29898018
DOI: 10.1590/1807-3107bor-2018.vol32.0031 -
International Journal of Environmental... Sep 2022Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is a global and evolving pandemic associated with heavy health and financial burdens. Considering the oral... (Meta-Analysis)
Meta-Analysis Review
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is a global and evolving pandemic associated with heavy health and financial burdens. Considering the oral cavity as the major reservoir for SARS-CoV-2, a systematic review and meta-analysis were conducted to assess the efficacy of mouth rinses and nasal sprays in reducing the salivary viral load of SARS-CoV-2. All and studies that assessed the virucidal efficacy of mouth rinses and nasal sprays against SARS-CoV-2 and were published in the English language from December 2019 to April 2022 were considered for analyses. Special Medical Subject Headings terms were used to search Pubmed, Scopus, Embase Ovid, and Web of Science databases. The toxicological data reliability assessment tool (ToxRToool) was used to assess the quality of the included studies. Thirty-three studies (11 and 22 ) were deemed eligible for inclusion in this analysis. Results of the pooled data showed that povidone-iodine is the most efficacious intervention in terms of reducing the SARS-CoV-2 salivary viral load, followed by chlorhexidine. The mean difference in the viral load was 86% and 72%, respectively. Similarly, povidone-iodine was associated with the highest log reduction value (LRV) , followed by cetylpyridinium chloride, (LRV = 2.938 ( < 0.0005) and LRV = 2.907 ( = 0.009), respectively). Povidone-iodine-based oral and nasal preparations showed favourable results in terms of reducing SARS-CoV-2 viral loads both and . Considering the limited number of patients , further studies among larger cohorts are recommended.
Topics: COVID-19; Cetylpyridinium; Chlorhexidine; Humans; Mouthwashes; Nasal Sprays; Povidone-Iodine; Reproducibility of Results; SARS-CoV-2
PubMed: 36231450
DOI: 10.3390/ijerph191912148 -
Journal of Cranio-maxillo-facial... Apr 2016Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no... (Review)
Review
INTRODUCTION
Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no study on the overall complication or satisfaction rate associated with the various grafting techniques exists. We performed a comprehensive literature review to determine the outcomes and complications of eyelid fat grafting, as well as patient satisfaction.
METHODS
A systematic review of the literature using the PRISMA criteria was conducted. This protocol was registered at the Prospective Register of Systematic Reviews at the National Institute for Health Research.
RESULTS
Sixteen studies, representing 1,159 patients and published between June 2004 and December 2014, were included. Satisfactory results, judged by clinical examination, were observed in all studies. Few postoperative complications were reported.
CONCLUSIONS
We demonstrated that the procedures were easy to perform, and achieved satisfactory and sustainable results with few complications in both reconstructive and cosmetic surgery. However, a wide disparity exists in the various fat harvesting, fat purification, and reinjection techniques. Further studies are required to assess the long-term outcomes. Our conclusions should be accepted cautiously due to the small number of articles and the lack of evidence in published studies.
Topics: Adipose Tissue; Eyelids; Humans; Patient Satisfaction; Prospective Studies; Plastic Surgery Procedures; Retrospective Studies; Tissue and Organ Harvesting; Transplantation, Autologous
PubMed: 26880013
DOI: 10.1016/j.jcms.2015.12.013 -
Journal of Robotic Surgery Jun 2024The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and... (Meta-Analysis)
Meta-Analysis Review
The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.
Topics: Female; Humans; Abdominal Wall; Lymph Node Excision; Microsurgery; Operative Time; Plastic Surgery Procedures; Robotic Surgical Procedures
PubMed: 38878229
DOI: 10.1007/s11701-024-01987-7 -
Brain Imaging and Behavior Oct 2022Motor training is a widely used therapy in many pain conditions. The brain's capacity to undergo functional and structural changes i.e., neuroplasticity is fundamental... (Review)
Review
Motor training is a widely used therapy in many pain conditions. The brain's capacity to undergo functional and structural changes i.e., neuroplasticity is fundamental to training-induced motor improvement and can be assessed by transcranial magnetic stimulation (TMS). The aim was to investigate the impact of pain on training-induced motor performance and neuroplasticity assessed by TMS. The review was carried out in accordance with the PRISMA-guidelines and a Prospero protocol (CRD42020168487). An electronic search in PubMed, Web of Science and Cochrane until December 13, 2019, identified studies focused on training-induced neuroplasticity in the presence of experimentally-induced pain, 'acute pain' or in a chronic pain condition, 'chronic pain'. Included studies were assessed by two authors for methodological quality using the TMS Quality checklist, and for risk of bias using the Newcastle-Ottawa Scale. The literature search identified 231 studies. After removal of 71 duplicates, 160 abstracts were screened, and 24 articles were reviewed in full text. Of these, 17 studies on acute pain (n = 7) or chronic pain (n = 10), including a total of 258 patients with different pain conditions and 248 healthy participants met the inclusion criteria. The most common types of motor training were different finger tasks (n = 6). Motor training was associated with motor cortex functional neuroplasticity and six of seven acute pain studies and five of ten chronic pain studies showed that, compared to controls, pain can impede such trainings-induced neuroplasticity. These findings may have implications for motor learning and performance and with putative impact on rehabilitative procedures such as physiotherapy.
Topics: Humans; Magnetic Resonance Imaging; Neuronal Plasticity; Transcranial Magnetic Stimulation; Motor Cortex; Chronic Pain; Chronic Disease
PubMed: 35301674
DOI: 10.1007/s11682-021-00621-6